"It's professional but it's personal": Participation, personal connection, and sustained disagreement in drug policy reform.

While there is widespread agreement as to the importance of increasing participation in drug policy design, drug policy literature contains limited reflection on the practices that may support inclusion and collaboration amongst policy actors, particularly when disagreement and difference are an intrinsic part of participation. Drawing on qualitative interviews and ethnographic fieldwork with actors engaged in an Australian illicit drug policy reform campaign, this paper examines how particular modes of personal connection mattered in establishing and maintaining working relationships between a range of differently situated actors. Through engagement with this case study, we argue that modes of personal connection marked by qualities such as being frank; engaged; not forcing consensus; enacting respect; listening in order to understand; and acting in ways that respected the obligations and limits that came with people's roles while also recognising one another as more than those roles, were particularly important qualities that supported connection across difference. Such personal connections seem to have been even more important for the engagement of people representing more marginal positionalities. Arguing that personal connection is already an element of both inclusion and exclusion in drug policy creation, we suggest that policy actors interested in contributing to a more diverse and rigorous policy participation space attend to how people connect, with whom, and with what space for disagreement, while also taking seriously the labour of such connection across difference.

Navigating the grey: Experiences of incremental cannabis reform in Australia.

INTRODUCTION AND AIMS: There have been many changes to cannabis laws across the globe, some dramatic but more often incremental. This study explored the experiences after an incremental cannabis law reform in the Australian Capital Territory, Australia. METHOD: Semi-structured interviews (n = 30) were conducted in March and April 2021, 14 months after the introduction of cannabis law reform, with people aged 18 and over who had grown and/or consumed cannabis in the previous 12 months. Participants were asked about recent and past cannabis use, growing cannabis and changes to their practices after the introduction of the legislation. RESULTS: Incremental cannabis law change resulted in regulatory grey areas. How people interpreted and navigated such grey areas were connected to their relative privileges, circumstances and histories. Those who were highly policed were more likely to experience the grey areas negatively. Those who were not highly policed found the grey areas confusing or 'half-arse' (insufficiently executed), but mostly experienced the new laws positively through new cannabis cultivation or perceived reduction in stigma and fear of arrest. Those with self-identified privilege were unconcerned with grey areas of the legislation. DISCUSSION AND CONCLUSION: Incremental policy change can result in grey areas that require some navigation. Vulnerable populations appear less likely to experience the full benefits of such incremental drug law reform. It is vital to attend to the inequities that can arise from incremental law reform so that positive experiences are shared across the population regardless of relative privilege.

Examining untreated and treated alcohol problem resolution in an Australian online survey sample.

INTRODUCTION: While treatment is an effective way to resolve alcohol problems, many people resolve their alcohol problems in the absence of treatment. Just how many do so is not known and may vary based on the definition of treatment. Various estimates of untreated alcohol problem resolution were calculated in this study, and the differences between people who resolve their alcohol problems with or without treatment were explored in relation to sociodemographic variables, levels of alcohol consumption in the past 12 months and lifetime alcohol problem severity. METHODS: A cross-sectional online survey was administered to 719 people who had resolved an alcohol problem in Australia. Convenience sampling was used through a recruitment strategy targeted towards the general population via Facebook. RESULTS: Almost half (49.8%) of all people who resolved their alcohol problem did so in the absence of alcohol treatment, whether specialist alcohol treatment, mutual-aid services or digital support services. When accessing mental health treatment is included under the scope of 'treatment', this estimate dropped to 12.8%. The estimated odds of having accessed treatment increased with age and lifetime alcohol problem severity. Other sociodemographic variables, or levels of alcohol consumption in the past 12 months, were not significantly associated with treatment status. DISCUSSION AND CONCLUSIONS: It might be beneficial to expand the scope of 'treatment' to include mental health services and focus on the development of cost-effective and less intrusive standalone activities, which can expedite and support alcohol problem resolution for those who choose not to access specialist treatment.

Recovery from alcohol problems in the absence of treatment: a qualitative narrative analysis.

BACKGROUND AND AIMS: Recovery from alcohol problems in the absence of treatment or mutual-aid is very common, but under-researched. This study explores the lives of people who had resolved their alcohol problems without treatment, seeking to situate experiences of recovery in social contexts and broader life narratives. DESIGN: The in-depth qualitative interviews were aided by a life-history methodology that invited participants to account retrospectively for their lives. A narrative analysis was undertaken. SETTING: Two major cities (Sydney and Melbourne) in Australia. PARTICIPANTS: People who had resolved an alcohol problem in the absence of treatment (n = 12) were recruited from the general community using convenience sampling. MEASUREMENTS: Eligible participants had received 'minimal treatment' for an alcohol use disorder: fewer than three sessions in an outpatient treatment programme or nine sessions with mutual-aid groups (e.g. Alcoholics Anonymous), or having accessed mental health treatment for problems other than drinking at least 2 years prior or 1 year after having resolved an alcohol problem. Participants were considered to have had an alcohol use disorder if they reported two or more symptoms (DSM-V) within a 1-year period prior to the past year, using questions endorsed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). People were considered to have resolved their alcohol use disorder by responding to the recruitment message calling for people who "used to have an alcohol problem but no longer do". The Alcohol Use Disorders Identification Test (AUDIT-C) was used to understand participant's drinking behaviours in the past 12 months. FINDINGS: Four different narratives were identified in the analysis. In the emancipation narrative, identity development and major changes across the life-curve were associated with separating oneself from an oppressive circumstance. In discovery narratives, art culture and other consciousness-expanding experiences were sources of identity development, but sometimes a barrier to alcohol recovery. In mastery narratives, life events were understood as failures or successes, and recovery was positioned as an individual journey accomplished through increased problem awareness. Finally, in coping narratives, changes were understood as a series of continuous struggles, and recovery was made sense of through diagnostic discourses. CONCLUSIONS: People who resolve an alcohol use disorder in the absence of treatment or mutual-aid appear to explain their recovery in terms of at least four different life narratives: emancipation, discovery, mastery or coping. Social contexts and cultures outside the treatment setting, and the various identities and narratives they provide, shape change processes.

Systematic review of untreated remission from alcohol problems: Estimation lies in the eye of the beholder.

BACKGROUND: Remission from alcohol problems in the absence of treatment is common, yet there are wide ranging estimates of the extent to which this occurs, depending on method. A systematic review of the literature on untreated remission from alcohol problems was conducted to analyse the ways different definitions and study designs impact on estimates of untreated remission from alcohol problems, and to explore the implications for treatment planning. METHODS: 2103 texts were identified through systematic searches of databases (Medline, PsycINFO, EMBASE) and other searches. Peer-reviewed journal articles published since 1975 which provided numeric estimates of untreated remission from alcohol problems were included. A narrative synthesis was undertaken. RESULTS: 124 estimates of untreated remission from alcohol problems were extracted from 27 studies. Three different sampling methods were identified: taking an 'alcohol problems sample' (method 1) which estimated the proportion of people with alcohol problems who remit without treatment; taking an 'untreated sample' (method 2) which estimated the proportion of untreated people who enter remission; and taking a 'remitted sample' (method 3) which estimated the proportion of people in remission who have not received treatment. In addition to this sampling diversity, the definitions of an alcohol problem, definitions of remission, and definitions of treatment varied between studies. The combination of the methods and definitional issues impacted on estimates of untreated remission from alcohol problems. CONCLUSIONS: Estimates derived from the 'alcohol problems sample' (method 1) and 'untreated sample' (method 2) are the most appropriate for treatment planners. How a treatment planner defines what treatment is, what remission is, and how an alcohol problem is defined all matter for these estimates.

Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand.

OBJECTIVE: Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. METHOD: A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. RESULTS: Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. CONCLUSIONS: Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

Antipsychotic medication and oxidative cell stress: a systematic review.

OBJECTIVE: To look at (1) the association between antipsychotics and cell stress, (2) whether first-generation antipsychotics may show different effects than second-generation antipsychotics, and (3) whether recommendations can be made regarding medication. DATA SOURCES: We conducted a systematic review of 5 databases for all articles published until December 31, 2007: PubMed, Ovid MEDLINE, EMBASE, PsycINFO, and EBM Reviews. Under specific headings (eg, "heat shock proteins" and "oxidative stress"), a systematic search of these databases included such terms as HSP70 and homocysteine, and specific search strings were constructed. No limits were placed on the year or language of publication. References from pertinent articles or books were retrieved. STUDY SELECTION: We included 42 articles of human studies from 2,387 references originally retrieved. We included only articles that (1) were quantitative; (2) referred only to human tissue, in vivo, or in vitro; (3) stated what tissue was examined; (4) identified what metabolites were measured; and (5) had references. DATA EXTRACTION: All articles were assessed by 2 authors, which ensured that the inclusion criteria were met. The selected studies were too heterogeneous to be combined for any useful meta-analysis. Three authors, therefore, independently interpreted the data, using specified criteria to judge whether each study showed a beneficial, detrimental, or no effect on the markers measured. DATA SYNTHESIS: The analysis revealed no conclusive association with direct or indirect markers of oxidative cell stress and antipsychotics. For every reviewed antipsychotic, we revealed differing research results showing a beneficial, detrimental, or no effect. This was true for in vivo as well as in vitro studies. CONCLUSIONS: It remains unclear whether antipsychotics increase or reduce cell stress. Claims of neuroprotective properties of antipsychotics seem premature.